Determinants of outcome following left ventricular aneurysmectomy

The determinants of outcome after left ventricular aneurysmectomy are not well understood. We analyzed preoperative follow-up information on 38 patients who had undergone left ventricular aneurysmectomy. At a mean follow-up of 39 months (range 6 to 68), 25 patients (66%) improved by at least one functional class (New York Heart Association) (Group I), and 13 patients (Group II) either died (n: 8) or had persistent congestive heart failure (n: 5). Patients in Group I had significantly higher left ventricular ejection fraction before surgery than patients in Group II (38 +/- 12% vs. 29 +/- 14%, P less than 0.04). The volume of the aneurysm at end-diastole was smaller among patients in Group I than Group II (42 +/- 32 ml vs. 73 +/- 47 ml, P less than 0.04). The contractile indices of the nonaneurysm segment, contractile segment ejection fraction, basilar half ejection fraction, and basilar fractional area shortening were not significantly different between the two groups. There was no difference between the two groups in the preoperative left ventricular end-diastolic pressure, cardiac index, pulmonary artery wedge pressure, pulmonary artery pressure, extent of coronary artery disease, number of bypass grafts inserted, or aortic cross-clamp times.

1) The ejection fraction and volume of the aneurysm are more important predictors of outcome after left ventricular aneurysmectomy than the contractile indices of the nonaneurysmal left ventricle and 2) symptomatic improvement occurs in 66% of patients after left ventricular aneurysmectomy.